1831571413 NPI number — WYOMING VALLEY ALCHOL AND DRUG SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831571413 NPI number — WYOMING VALLEY ALCHOL AND DRUG SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING VALLEY ALCHOL AND DRUG SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831571413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
437 NORTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-820-8888
Provider Business Mailing Address Fax Number:
570-820-8899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 EAST THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-820-8888
Provider Business Practice Location Address Fax Number:
570-820-8899
Provider Enumeration Date:
06/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HARLEN
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-820-8888

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  197057 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com